Paradigm Shifts

By: Marcus Heisler

About 30 percent of US medical students participate in global health experiences by the time they graduate from med school. These experiences range from shadowing world-class physicians in technologically advanced foreign hospitals to being the first-assist on a life-saving surgery in a remote rural health center. Most of these experiences are clinic-based, mimicking the sort of experiences one gets in the US; some experiences revolve more around research, providing more of an academic education. Few of these experiences, I’d bet, involve observing a woman with a fourth-grade education diagnosing diabetes by adding Benedict’s solution to the patient’s urine and heating it over a charcoal stove. Though very brief, I believe that my four-week rotation at CRHP will have a significant impact on my life and future career. The readings, village visits, interviews with village health workers and farmers’ club members, and the countless conversations with doctors, researchers, interns, students and international visitors, all caused a shift in the paradigms I had inherited in my previous training.

For example, on my second day at CRHP, I met Lalanbai. Prior to working for CRHP as a village health worker, she describes herself as having been illiterate and shy. Today, she has delivered over 700 newborn babies, is literate, and confidently speaks in front of large groups of people. Another example is Babai, who initially had serious misgivings about becoming a village health worker due to her little experience with deliveries and healthcare in general, but through her training and diligent work in her village, she earned the trust of her neighbors and the position of village mayor–and later received a national award in Delhi for her work. I understand now that people with little education can be given responsibilities that the medical community has reserved for those with advanced degrees, and that these same people, if well-supported and equipped, often accomplish more behavioral changes and public health improvements in their villages than doctors ever could.

Along that same line, I also learned that the job of those with advanced degrees is really to educate others and to demystify and decentralize medical knowledge. I plan to adopt this principle and utilize it as often as I can in my future career–whether that means stopping to explain the underlying physiology to interested patients or recommending resources such as YouTube videos or books to those wanting more information.

By observing the interactions between the mobile health team and farmers’ clubs and from reading literature on the subject, I saw how behavioral change and health improvement happens not necessarily on the patient level, but on the community level. This change is best achieved and longer lasting when initiated by the community itself, prompted by community-based research, and minimally but appropriately supported by outside experts and governmental policies.

Most significant, however, were the simple conversations I had with visiting developers, researchers, and the resident doctors, interns and support staff. There is, of course, a lot to health that isn’t in medical school curriculum, and community development is one of the bigger deficits (though understandably so). Nearly everyone I interacted with during those four weeks taught me about community development–how it is sometimes done correctly, and how it is often done incorrectly. I also learned how important it is to keep your organization’s primary purpose in mind even as you grow and seek out donors, how health and development are movements, and that the greatest resources will always be the people involved. Lastly, I’ve realized that we always approach new situations with our own biases, which can lead to prejudiced assumptions, but also helpful questioning and that we cannot give empowerment, but we can create an atmosphere that empowers.

It was inspiring to see up-close, new ways of thinking about medicine and bringing health to the poorest, and refreshing to read about and discuss these principles with the CRHP team. It will be challenging to not simply remember these principles, but to utilize and act upon them as I transition back to my western culture and medical paradigm. There are many foreseeable external and internal barriers to implementing a CRHP-like model in the US, but at least the relevant questions have been prompted in my mind: Can we give the power to improve health back to the community and to the lesser educated? Can we decentralize or demystify medicine better? And, how can development and empowerment, rather than advancing medical technology, fix the health care problems we face today?